肿胀有二∶一因于水，水气停蓄于肌肤或脏腑，因而肌肤浮肿，肚腹膨胀
也。其色鲜明润泽，其皮光薄，（甚则如水晶。）其肉腐，其身重，其肿不速，每自下而上，
肿有分界，按其手足上，如糟如泥，成窟不起。（按而散之，猝不能聚也。肢体如是，
腹未必然。
以腹中气盛水多，水挟气能鼓起也。）一因于气，气热壅滞作胀，（所谓诸腹胀大，皆
属于热也。）或气寒
不运作胀，（所谓胃寒则 胀，脏寒生满病也。）或气实作胀，（实者，邪气实也。如气
因痰食虫血，七情郁滞，
而壅盛作胀，所谓脾气实则腹胀，胃气实则胀也。）或气虚作胀。（虚则不能运，所谓气虚中
满，太阴虚则鼓胀也。）其色苍老，皮浓肉坚。其胀或连胸胁，或倏然而胀者，阳性急速也。
或自上及下者，阳本乎上也。或通身尽胀者，气无不至也。以手按之，随手即起者，
如按气囊也。（两足或有按之不能猝起者，以气蒸成水，气亲上，水就下故也。）
证既不同，施治亦异。
然水与气本一物，（观嘘气成水，蒸水成气，可知矣。）病常相兼，（水蓄气必滞，
气郁水亦停。）则治水当
兼理气，（气行水自行。）治气当兼行水。（水行气亦通。）
治水当分阴阳。阴水，无火之水也，或益脾肺之阳，或补命门之火。阳
水，有火之水也，随火之所在而治之。（少年纵酒，湿热内蓄，最多此证。）
遍身肿，烦渴，小便赤涩，大便多闭，此属阳水。轻宜四磨饮（见气），添磨生枳壳，
兼进保和丸。（见伤饮食。）重则疏凿饮子利之，以通为度。（亦有虽烦渴，而大便
已利者，宜用五苓
加木通、大腹皮，以利小便。五苓见伤湿。）
遍身肿，不烦渴，大便自调，或溏泄，小便虽少而不赤涩，此属阴水，宜实脾
饮。小便如常，至晚有微赤，却无涩滞，亦属阴也，不可遽补，木香流气饮（见气），继
进复元丹。若大便不溏，气息（息疑急）胀满，宜四磨饮下黑锡丹。（见呃逆。）
阴水虽宜补阳，然小火不能胜大水，必先泻去其水，乃用暖药以补元气。阴水
虽寒，久亦郁而成热，寒本也，热标耳。
《金匮》分五水，曰∶风水，皮水，正水，石水，黄汗。
风水，脉浮，骨节疼痛，（水流关节。）或重而酸，（水在肌肤也。）发热无汗，恶风，（外感风
邪）。面目肿大，目下微肿如蚕，如新卧起状，（目下属太阴，又胃细筋散目下，土虚则水反克，
循胃脉而上注也。）颈脉动，（人迎脉也，水浮气上逆，故动。）时时咳，（水气侵肺。）
当发汗。脉浮而洪，浮
则为风，洪则为气，（气郁热也。）风气相搏，风强（风多于热也）则为瘾疹，身体为痒，痒为
泄风，（言痒者，名为泄风也。热为风所闭，欲泄不得泄，故作痒。）久为痂癞。（即养成疠疯。以
风热久不散，
郁而为湿，风热湿相蒸生虫，肌肉溃腐也。）气强则为水，（热多而不得外泄，则蒸气成水也。
）难以俯仰，
（水浸淫于肌肤筋脉中也。）风气相击，身体浮肿，汗出乃愈，此为风水。（此句上有恶风则虚，句下
有不恶风者小便通利，上焦有寒，其口多涎，此为黄汗之文，当是错简，删之。）风水脉浮，身
重汗出恶风者，防己黄 汤主之。（固表以散风水。）腹痛加芍药。（加芍药、甘草以调中。）风水恶
风，一身悉肿，脉浮，不渴，续自汗出，无大热，越婢汤主之。恶风（汗出而恶风，则为
表阳虚）加附子。
皮水，皮受水湿也。脉浮，（水在皮肤故浮。） 肿，（湿邪从下受，故足跗浮肿。）按之没
指，不恶风，（非风邪也。）其腹如鼓，（如鼓，则非鼓也。以水在皮肤，不在腹内，故外有胀形，而内
无满喘也。）不渴，（在表故不渴。）当发汗。渴而不恶寒者，此为皮水。（独有水而无风，故不恶风寒。
渴者，盖皮水亦有浅深之分，深而近里，亦足以抑遏阳气，不化津液，故渴也。）皮水为病，四肢肿，水气
在皮肤中，防己茯苓汤主之。里水，（当根据《金鉴》作皮水。）越婢加术汤主之，甘草麻黄汤亦主之。
正水，（肾脏之水自盛也。）其腹如鼓，脉沉迟，喘。（水泛于上，故喘。）
石水，脉沉，腹满不喘。（阴盛结于少腹，如石之下沉也。惟其下沉不上干，故不喘。）
黄汗，（汗出沾衣，如黄柏汁。湿土为热所蒸，故色黄如此。）脉沉迟，身发热，（湿滞阳气不行，故郁
而成热。）胸满，四肢头面肿，不愈，必致痈脓。（湿热久而愈盛，气血被其壅塞，而成痈脓。）
身肿而冷，状如周痹，胸中塞，不能食，（湿滞也。）反聚痛，（热为寒湿所郁，相攻击，故聚痛。聚，
结也。）暮躁不得眠，（暮则寒湿愈盛，热愈郁，故躁不得卧。）此为黄汗。黄汗身体肿，发热汗
出而渴，状如风水，（皆面目浮肿也。）脉自沉。以汗出入水中浴，水从汗孔入得之。（水
寒，遏郁汗液于肌内，为热所蒸而成黄汗。然汗出浴水，亦举隅之论耳，当推展之。）黄 芍药桂枝苦酒
（即醋）汤主之。（《金鉴》谓桂枝散邪，黄 固卫，白芍、苦酒止汗以摄营气，营卫调和自
愈。愚按此方无清热去湿之品，徒取固敛，得无壅乎？此方恐是错简，终不可用。）
按∶风水、皮水，皆水之在表者，以感风受湿为别，故有恶风与不恶风之分。
正水、石水，皆水之在里者，以上浮下沉为别，故有喘与不喘之异。黄汗，虽状如
风水，而风水脉不沉，汗不黄，自不同也。（黄汗当参黄胆门。）又按∶正水，水之上浮者，
必干肺，故喘。然肺自有水病，故《金匮》谓，痛在骨节，咳而喘，不渴者，此为
肺胀。（本文作脾胀，今从《金鉴》改之。）其状如肿，（似肿非肿，盖肺胀于中，未形于
外也。）发汗则愈。
（越婢加术汤。）又谓肺水，其身肿，（皮肤浮肿。）小便难，（肺气为水所壅，
不能通调水道，下输
膀胱。）时时鸭溏（水粪相杂也。肺合大肠，水趋之。）是也。又按∶石水，水之下
沉者，即《金匮》
所谓，肾水者，腹大脐肿腰痛，不得溺，阴肿，（阴肿，旧在心水下，今从《金鉴》移此。）阴下
湿如牛鼻上汗，其足逆冷，面反瘦，（言不若他水之面目浮肿也）是也。又《金匮》谓肝水者，
其腹大，不能自转侧，胁下腹痛，时时津液微生，小便续通，（水气上逆下降，
故津液有时生，小便有时通。盖肝喜冲逆，主疏泄，气得上下时通也。）心水者，身重少气，（即短气。）
不得卧，烦而躁。脾水者，腹大，四肢苦重，津液不生，（脾湿，谷气不运不升，故津液不生。）
但苦少气，则小便难。（气弱不化。）是各脏皆有水也。（水在肝部，则名肝水，随所在而名之。）
外水。腰以下肿，当利小便。（宜用贴脐等法。巴豆去油四钱，水银粉二钱，硫黄一钱，研匀成饼，
先用新绵一片布脐上，内饼，外用帛缚时许，泻下恶水三、五次，去药，白粥补住。弱者隔日取一次，
一饼可救三、
五人。一法，鲜赤商陆根捣贴，帛缚定，水自小便出。一法，田螺四个，大蒜五个，车前子末三钱，研成饼，贴
定帛缚，少时尿利则愈。或内服沉香琥珀丸，即苦葶苈子、郁李仁、防己、沉香、陈皮、琥珀、杏仁、
苏子、赤茯
苓、泽泻、麝香也。）腰以上肿，当发汗。（越婢汤加苍术。）喘急不得卧者，苏子、葶苈等分，
枣肉丸。四肢肿，宜五皮饮。（五皮饮，不论阴阳水，俱可先用。或除湿汤加木瓜、腹皮。如未效，四磨
饮兼吞桂黄丸，仍用赤小豆粥佐之。）感湿者，腰以下肿尤甚，五苓散（见伤湿）吞木瓜丸，（见中风。）
间进除湿汤（见中湿）加木瓜、腹皮、莱菔子（炒）。惟面与足肿，早则面甚，晚则足甚者，
风水也。（风上行则面肿，盖湿气非风不能上面也。湿下坠则足肿。）视大便之硬溏，别其证之阴阳，
除湿汤（见中湿）加木瓜、腹皮、白芷可通用。或以苏子降气汤（见气）、除湿汤各半贴煎服。
（单面肿，则独用苏子降气汤，单足肿，则用除湿汤。）内水。腹大，小便不利，脉沉甚，可下之。
（十枣汤、 川散、神佑丸、禹功散、舟车丸之类。盖水可从小便利，亦可从大便泄也。）病轻者，枳实
白术汤。（白术补土，枳实破坚。张元素治痞，变此汤为丸，以彼属食积所伤，故用丸以消磨之，
此水饮所作，故
用汤以荡涤之。）水胀，冬瓜宜长吃。鲤鱼重一斤以上者，煮取汁，和冬瓜、葱白作羹食
之。青头鸭或白鸭，去肠杂，细切，和米煮粥，空腹食之。老鸭（十年者佳）杀取血，俟
凝，银簪划片，烧酒热泡食之。鸭身去毛杂，烧酒顿烂，空心食，俱不着盐。服后
小便利，肿立消，忌盐三年。水肿外散内利，峻剂疏凿饮子，和剂茯苓导水汤。《医
贯》胃虚不能制水者，以补土为主，补中益气汤、六君子汤等。（二方并见气。实脾饮亦可。）
脾气旺则水自行，不必加行气利水之品。若肾火虚，三焦之气化不行，关门不利，
水聚不出，惟济生肾气丸（见虚损）最验。若肾水虚，火炎，水从火溢，上积于肺，喘不能
卧，腹大脐肿，腰痛，两足先肿，小水短涩，面赤或肿，口渴，大便反燥，六味（见虚损）
加麦冬、五味、牛膝、车前，（以上论水肿。）
气胀，又名鼓胀，以其外虽坚满，中空无物，（止气作胀耳。）有似乎鼓也。若兼中实
有物，（食痰虫血之类。）盘踞脏腑，如木之藏蠹，如皿之聚虫，则又名蛊胀。（又有中毒而
腹胀者，曰蛊毒。）鼓，脉必浮革，蛊，脉必牢实。治蛊如大黄、芒硝、牵牛、槟榔、三
棱，蓬术俱可用，一味地栗干最妙。气实作胀，宜浓朴等以破滞。气虚中满，宜补
气，加芍药等以收其散涣。更分寒热，虚而寒者，寒胀中满，分消汤；虚而热者，
热胀中满，分消丸。七情胀，五膈宽中散（见反胃）、木香流气饮、沉香降气汤。（并见气。）
大怒而胀，分心气饮。忧思过度而胀，紫苏子汤。大病后浮肿，白术三钱，参、
各一钱半，白茯二钱，陈皮、半夏曲、白芍、木香各一钱，炙草、大腹皮各五
分，姜、枣煎。久泻后胀者，六君子（见气）加白蔻、苏梗、当归，服后胀益甚，勿疑，
久自效。因气而成水肿，分气香苏饮。老人虚寒胀，浓朴、炮附、木香。
因饮食所伤者气必滞，胸满嗳气，消导宽中汤。失饥伤饱，痞闷停酸，早食暮不
能食，（早晨阳气长，谷易消，暮则阳气微，谷难化也。）大异香散。蓄血作胀，腹皮上见青紫筋，脉
芤涩，妇人多有此，先以桃仁承气汤，势重者抵当汤下之，或代抵当丸。（并见血。）虚
人不可下者，且以当归活血散调治。血胀多有烦躁，漱水不咽，迷忘如狂，
痛闷喘急，大便黑，小便利，虚汗（气为血郁，热蒸成汗。）厥逆等证，人参归芎汤。痰能
滞气，勿谓不能作胀，故古人治气为痰郁作胀，加味枳术汤。气水血三者，病常相
因，有先病气滞而后血结者，（如妇人先病气郁，后致月经不行者是也。）有病血结而后气滞者，
（如妇人先病月经不通，致气滞胀满是也。）有先病水肿而血随败者，（水积日久，渗透经络，灌入
隧道，血亦
化水。）有先病血结而水随蓄者，（血结则气滞，而热蒸成水，妇人月经不利，化水肿胀，皮肉赤纹，
椒仁丸、人参大黄汤。）须求其本而治之。积聚相攻，疼胀，初用七气消聚散，日久弱者，
参术健脾汤，少佐消导药。虫聚作胀，治法详虫门。（以上论气胀。食血痰虫积聚，虽非因气滞
使然，亦必因此滞气，并以理气为主，故皆属之气也。）
脏腑外，胸腹中，邪充塞，则胸腹胀矣。经络营卫，气无不到，则血脉皮肤，
无不胀矣。（故有脉、肤胀之名。脉胀者，筋起，络色变。木香流气饮治肤胀，加抚芎、姜黄治脉胀。）而欲知
为何部之邪，则先胀处，与胀甚处是也。（脾胃受邪，则先从胃脘痞塞起。又属脾胃者，则饮食少，
属他脏腑者，则饮食如常。又胀在皮肤、经脉者，饮食亦如常，在肠胃间者，则饮食少。皆宜细察。）更须分虚
实，其脏腑之气本盛，被邪填塞不行者为实；气本不足，因邪所壅者为虚。（虚中亦有
挟实，以其邪为食痰血湿等有形之物也。）实者驱之，虚者补之，寒者热之，热者寒之，结者散
之，留者行之。邪从外入内而盛于中者，先治其外而后调其中。阴从下逆上而盛于
中者，先抑之而调其中。阳从上降而盛于中者，先举之而调其中。手足不肿，独腹
胀，谓之单腹胀，俗名蜘蛛蛊，难治。（以病全聚于脏腑，不分散于四肢也。实者浓朴散，虚者调中健
脾丸。）服药后手足肿，病自内达外也，不久愈。若从手足肿至腹，为从外入内，难
治。男自下而上，（男阳盛，邪不易犯。今乃以渐上犯，则邪盛阳虚可知。）女自上而下，（女阴盛，
邪不易侵。今亦以渐下侵，则邪盛阴虚可知。）皆难治。（男止下肿，女止上肿，皆不足虑，不在难治之例。譬如草
Swelling is of two types: one is due to water, where water qi stagnates and accumulates in the skin/muscle or zang-fu organs, leading to edema of the skin and distension of the abdomen. The complexion is bright and lustrous, the skin is thin and shiny (in severe cases, resembling crystal), the flesh is soft and rotting, the body feels heavy, the swelling develops slowly, usually spreading from the lower extremities upward, with distinct boundaries. Pressing the hands and feet leaves an indentation like chaff or mud that does not rebound immediately. (If pressed, it scatters and cannot gather quickly again. This applies to the limbs; the abdomen may not necessarily be so. This is because there is abundant qi and water in the abdomen, and water carrying qi causes bulging.) The other type is due to qi, where heat-stagnant qi causes distension (as stated, "all abdominal distensions and enlargements belong to heat"), or cold-inactive qi causes distension (as stated, "cold stomach leads to distension, cold zang organs generate fullness diseases"), or excess qi causes distension (Excess refers to pathogenic excess. For example, qi becomes stagnant due to phlegm, food retention, parasites, blood stasis, or emotional depression, becoming congested and causing distension, as stated, "when spleen qi is excess, there is abdominal distension; when stomach qi is excess, there is distension"), or deficient qi causes distension (Deficiency means inability to transport, as stated, "qi deficiency leads to central fullness, splei yin deficiency leads to drum-like distension"). The complexion is dull and aged, the skin is thick, and the muscles are firm. The distension may extend to the chest and hypochondrium, or occur suddenly; sudden onset indicates a yang pattern, which is rapid. Distension spreading from top to bottom occurs because yang originates from above. Generalized whole-body distension occurs because qi reaches everywhere. Pressing with the hand results in immediate rebound, feeling like pressing an air bag. (The feet may sometimes not rebound immediately because qi transforms into water; qi tends to rise while water tends to sink, hence this phenomenon in the lower limbs.)
Since the syndromes differ, the treatments also differ. However, water and qi are essentially the same substance (one can understand this by observing breath condensing into water and water vaporizing into qi). Diseases often coexist (water accumulation causes qi stagnation; qi depression causes water retention). Therefore, treating water should involve regulating qi (where qi moves, water moves); treating qi should involve promoting water metabolism (where water moves, qi also flows).
Treating water requires distinguishing between yin and yang. Yin water is water without fire; treatment involves tonifying the yang of the spleen and lungs, or supplementing the fire of the Mingmen (Gate of Vitality). Yang water is water with fire; treatment follows the location of the fire. (This syndrome is most common in young people who indulge in alcohol, leading to internal accumulation of damp-heat.) Generalized swelling, thirst with irritability, dark and scanty urine, and frequent constipation belong to Yang Water. For mild cases, Si Mo Yin (Four-Mortar Drink) [see Qi] with raw Zhi Qiao (Immature Bitter Orange) ground into it, taken concurrently with Bao He Wan (Preserve Harmony Pill) [see Food Injury], is appropriate. For severe cases, Shu Zao Yin Zi (Draining and Sifting Decoction) is used to promote urination, aiming for unobstructed flow. (In cases where there is thirst but stool is already loose, Wu Ling San (Five-Ingredient Powder with Poria) plus Mu Tong (Akebia Caulis) and Da Fu Pi (Areca Peel) should be used to promote urination. Wu Ling San [see Damp Injury].)
Generalized swelling without thirst, normal or loose stools, and although urine volume is low, it is neither dark nor painful/burning belongs to Yin Water. Shi Pi Yin (Solidify the Spleen Decoction) is indicated. If urine is normal but slightly reddish late at night without burning sensation, it also belongs to a yin pattern; do not rush to tonify. Use Mu Xiang Liu Qi Yin (Mu Xiang Flowing Qi Decoction) [see Qi], followed by Fu Yuan Dan (Restore Primordial Pill). If stools are not loose but breathing is rapid and there is distension, Si Mo Yin administered with Hei Xi Dan (Black Tin Pill) [see Hiccups] is suitable.
Although Yin Water is suitable for warming yang, a small fire cannot overcome large amounts of water. One must first drain the water before using warm medicines to tonify primordial qi. Although Yin Water is cold, prolonged stagnation may transform into heat; cold is the root, heat is the branch.
*Jingui Yaolue* classifies water disorders into five types: Feng Shui (Wind Water), Pi Shui (Skin Water), Zheng Shui (Regular Water), Shi Shui (Stone Water), and Huang Han (Yellow Sweat).
Feng Shui presents with floating pulse, pain in bone joints (water flowing into joints), heaviness and soreness (water in skin/muscle), fever, no sweat, aversion to wind (external wind pathogen invasion), swelling of face and eyes, slight swelling under eyes resembling silkworms or fresh waking state (under-eye area belongs to Taiyin, and is where fine meridians of Stomach scatter; when earth is deficient, water overacts, following Stomach meridian upward), pulsation of neck vessels (Renying pulse, water floats and qi rebels upward causing pulsation), occasional cough (water qi invading lungs). Treatment requires inducing sweating. A floating and surging pulse indicates floating is wind, surging is qi (qi depression with heat). When wind and qi fight, if wind dominates (wind exceeds heat), urticaria occurs, causing body itching; itching is called Xie Feng (Leaking Wind). Heat closed by wind cannot vent, causing itching. Prolonged case leads to scabs and leprosy (leprosy forms as wind-heat persists, transforms into dampness, wind-heat-dampness steams producing worms, rotting muscle). If qi dominates, water forms (excess heat unable to vent externally transforms into steam/water), difficulty bending/straightening (water infiltrating skin/muscle/meridians). Wind and qi striking each other causes generalized swelling; sweating leads to recovery, termed Feng Shui. (Note: Text regarding "aversion to wind implies deficiency" and "no aversion to wind, clear urine, upper jiao cold, salivation, termed Yellow Sweat" appears misplaced here and should be deleted as a textual error.) For Feng Shui with floating pulse, heavy body, sweating, and aversion to wind, Fang Ji Huang Qi Tang (Aristolochia and Astragalus Decoction) is prescribed to secure the exterior and disperse wind-water. Add Bai Shao (White Peony Root) for abdominal pain (with Gan Cao to harmonize the middle). For Feng Shui with aversion to wind, generalized swelling, floating pulse, no thirst, continuous spontaneous sweating, and no significant heat, Yue Bi Tang (Yue Bi Decoction) is prescribed. Add Fu Zi (Prepared Aconite Root) if aversion to wind is present (sweating with aversion to wind indicates exterior yang deficiency).
Pi Shui (Skin Water) involves water-dampness affecting the skin. Pulse is floating (water in skin), swelling (dampness enters from below, causing foot edema), indentation upon pressure, no aversion to wind (not wind pathogen), abdomen like a drum (distended externally but not internally full/gas-filled because water is in skin, not abdomen, so no fullness/stuffiness), no thirst (pathogen in exterior). Treatment requires inducing sweating. Thirst without aversion to cold is Pi Shui. (Only water without wind, hence no aversion to wind/cold. Thirst occurs because deep Pi Shui suppresses yang qi, failing to transform fluids.) For Pi Shui with limb swelling and water qi in skin, Fang Ji Fu Ling Tang (Aristolochia and Poria Decoction) is prescribed. Li Shui (Interior Water - likely a textual variant for Pi Shui per *Yizong Jinjian*) is treated with Yue Bi Jia Zhu Tang (Yue Bi Decoction plus Atractylodes Macrocephala Rhizome) or Gan Cao Ma Huang Tang (Licorice and Ephedra Decoction).
Zheng Shui (Regular Water) involves excessive water from Kidney. Abdomen like a drum, sinking-slow pulse, wheezing (water flooding upward causes wheezing).
Shi Shui (Stone Water) has sinking pulse, abdominal fullness without wheezing (yin excess knots in lower abdomen like sinking stone; since it sinks and does not affect upper jiao, there is no wheezing).
Huang Han (Yellow Sweat) features sweat staining clothes yellow like Phellodendron bark juice (damp-earth steamed by heat turns yellow). Sinking-slow pulse, body fever (dampness obstructs yang qi, leading to heat depression), chest fullness, swelling of limbs/head/face. If untreated, abscesses/pus form (long-standing damp-heat obstructs qi/blood). Body swollen and cold, resembling Zhou Bi (circulating bi), chest obstruction, inability to eat (dampness obstruction), intermittent pain (heat郁 by cold-damp attacks, pain clusters/clots), evening restlessness insomnia (cold-damp increases at night, heat郁 worsens, causing restlessness). This is Huang Han. Huang Han with body swelling, fever, sweating, thirst, resembling Feng Shui (facial swelling), with sinking pulse, is caused by bathing in water while sweating, allowing cold water to enter pores (cold water inhibits sweat, steamed by heat into yellow sweat. Bathing while sweating is just one example; principles should be extended). Huang Qi Shao Yao Gui Zhi Ku Jiu Tang (Astragalus, Peony, Cinnamon Twig, and Vinegar Decoction) is prescribed. (*Yizong Jinjian* says Gui Zhi disperses pathogens, Huang Qi secures defense, Bai Shao and vinegar stop sweating to capture Ying qi, harmonizing Ying/Wei cures itself. I argue this formula lacks clearing heat/dampness ingredients, merely securing/astringing, potentially causing stagnation? This formula may be a textual error and ultimately unusable.)
Commentary: Feng Shui and Pi Shui are water in the exterior, distinguished by wind vs. damp invasion, hence presence/absence of aversion to wind. Zheng Shui and Shi Shui are water in the interior, distinguished by floating vs. sinking, hence presence/absence of wheezing. Huang Han resembles Feng Shui but differs in pulse (not floating) and sweat color (yellow). (Refer to Jaundice section for Huang Han.) Also: Zheng Shui, water floating upward, affects Lung, causing wheezing. Lung has its own water disease; *Jingui* states pain in joints, cough/wheezing, no thirst is Fei Zhang (Lung Distension). (Text originally said Pi Zhang, corrected to Fei Zhang per *Yizong Jinjian*). Resembles swelling (internal distension not yet external), cured by sweating (Yue Bi Jia Zhu Tang). Also Fei Shui (Lung Water): body swelling (skin edema), difficult urination (Lung qi obstructed by water, unable to regulate water passages to Bladder), frequent loose stools (water mixes with feces; Lung pairs with Large Intestine, water follows). Also: Shi Shui, water sinking, corresponds to *Jingui*'s Shen Shui (Kidney Water): abdominal enlargement, umbilical swelling, back pain, inability to urinate, genital swelling (moved from Heart Water section per *Yizong Jinjian*), genital wetness like ox nose sweat, cold feet, thin face (unlike other waters with facial swelling). *Jingui* also describes Gan Shui (Liver Water): abdominal enlargement, inability to turn side-to-side, hypochondriac/abdominal pain, occasional saliva production, intermittent urination (water qi rebels up and down, so saliva/urination vary; Liver likes rebellion, governs free flow, qi moves up/down intermittently). Xin Shui (Heart Water): heavy body, shortness of breath, inability to lie down, irritability/restlessness. Pi Shui (Spleen Water): abdominal enlargement, heavy limbs, lack of fluid generation (Spleen dampness, grain qi fails to transport/rise, so fluids not generated), only shortness of breath, difficult urination (weak qi fails to transform). Thus, each zang organ has water disease (named according to location).
External Water: Swelling below waist requires promoting urination. (Methods include navel application: Croton seed oil-free 4 qian, Calomel 2 qian, Sulfur 1 qian, ground into cake. Place cotton on navel, apply cake, bind for some time, purge foul water 3-5 times, remove medicine, feed white porridge to restore. Weak patients once every other day; one cake saves 3-5 people. Alternative: Fresh Red Phytolacca root mashed and applied, bound, water exits via urine. Alternative: 4 river snails, 5 garlic cloves, 3 qian Plantago seed powder, ground into cake, applied, bound, urination restores health. Or internal Chen Xiang Hu Po Wan (Agarwood and Amber Pill): Galium seeds, Prunus seeds, Aristolochia, Agarwood, Tangerine peel, Amber, Almond, Perilla fruit, Red Poria, Alisma, Musk.) Swelling above waist requires inducing sweating (Yue Bi Tang plus Cang Zhu). Wheezing/urgency/inability to lie down: Su Zi and Ting Li equal parts, date paste pills. Limb swelling: Wu Pi Yin (Five-Bark Decoction). (Wu Pi Yin works for both yin/yang water initially. Or Chu Shi Tang plus Mu Gua, Da Fu Pi. If ineffective, Si Mo Yin combined with Gui Huang Wan, aided by Adzuki bean porridge.) Dampness invasion: swelling below waist worse. Wu Ling San taken with Mu Gua Wan, alternating with Chu Shi Tang plus Mu Gua, Da Fu Pi, Radish seed (stir-fried). Only face and foot swelling, worse in morning (face) or evening (feet), is Feng Shui. (Wind rises causing facial swelling; dampness falls causing foot swelling.) Observe stool hardness/looseness to distinguish yin/yang. Chu Shi Tang plus Mu Gua, Da Fu Pi, Bai Zhi is generally applicable. Or half dose Su Zi Jiang Qi Tang and half Chu Shi Tang decocted together. (Single face swelling: use Su Zi Jiang Qi Tang alone. Single foot swelling: use Chu Shi Tang alone.)
Internal Water: Abdominal enlargement, difficult urination, very sinking pulse, can be purged. (Shi Zao Tang, Zhou Che Wan, etc. Water can exit via urine or stool.) Mild cases: Zhi Shi Bai Zhu Tang. (Bai Zhu tonifies Earth, Zhi Shi breaks hardness. Zhang Yuansu changed this to pill for food stagnation; here used as decoction for water retention to scour it.) For water distension, eat winter melon regularly. Carp over 1 jin boiled for broth, mixed with winter melon and scallion whites as soup. Green-headed or white duck, cleaned, chopped, cooked with rice as porridge, eaten fasting. Old duck (10 years best), blood collected, solidified, sliced with silver needle, soaked in hot liquor, eaten. Duck meat stewed in liquor, eaten fasting, no salt. After taking, urination increases, swelling disappears quickly; avoid salt for three years. For external dispersion and internal drainage of edema, strong agent Shu Zao Yin Zi, mild agent Fu Ling Dao Shui Tang. *Yi Guan*: Spleen/Stomach deficiency failing to control water requires tonifying Earth: Bu Zhong Yi Qi Tang, Liu Jun Zi Tang, etc. (Also see Qi section. Shi Pi Yin also applicable.) When Spleen qi is robust, water moves naturally, no need for qi-moving/diuretic herbs. If Kidney fire is deficient, San Jiao qi transformation fails, gate closure improper, water accumulates, Ji Sheng Shen Qi Wan is most effective. If Kidney yin is deficient, fire flares, water overflows from fire, accumulates in Lung, wheezing/inability to lie down, abdominal enlargement/umbilical swelling/back pain, foot swelling first, scanty/dysuric urine, red/swollen face, thirst, dry stool, Liu Wei Di Huang Wan plus Mai Dong, Wu Wei Zi, Niu Xi, Che Qian Zi. (Above discusses edema.)
Qi Distension, also called Drum Distension, because exterior is hard/full but hollow inside (only qi causing distension), resembling a drum. If accompanied by internal solid masses (food, phlegm, parasites, blood) occupying zang-fu, like wood harboring termites or vessel gathering insects, it is called Gu Distension. (Poison-induced abdominal distension is called Gu Du.) Drum distension pulse is floating/reed-like; Gu distension pulse is firm/solid. Treating Gu allows Da Huang, Mang Xiao, Qian Niu, Bing Lang, San Leng, Peng Ze; single Di Li Gan (Water Chestnut dried) is best. Excess qi distension: Hou Po etc. to break stagnation. Deficient qi central fullness: tonify qi, add Bai Shao etc. to gather scattered qi. Further distinguish cold/heat: Deficient-cold distension uses Fen Xiao Tang; Deficient-heat distension uses Fen Xiao Wan. Seven Emotions distension: Wu Ge Kuan Zhong San, Mu Xiang Liu Qi Yin, Chen Xiang Jiang Qi Tang. Distension after great anger: Fen Xin Qi Yin. Distension after excessive worry/thought: Zi Su Zi Tang. Post-major illness edema: Bai Zhu 3 qian, Ren Shen/Gan Cao 1.5 qian each, Bai Fu Ling 2 qian, Chen Pi, Ban Xia Qu, Bai Shao, Mu Xiang 1 qian each, Zhi Gan Cao, Da Fu Pi 0.5 qian each, Ginger/Jujube decocted. Distension after chronic diarrhea: Liu Jun Zi plus Bai Kou, Su Geng, Dang Gui. If distension worsens after taking, do not doubt, it will eventually work. Edema due to qi: Fen Qi Xiang Su Yin. Elderly deficient-cold distension: Hou Po, Pao Fu Zi, Mu Xiang.
Food injury causes qi stagnation, chest fullness/hiccups, Xiao Dao Kuan Zhong Tang. Irregular eating/starvation/fullness, stuffiness/acid retention, morning eating ok but evening unable to eat (morning yang grows, grain digests easily; evening yang weak, grain hard to digest), Da Yi Xiang San. Blood stasis distension: blue-purple veins on abdominal skin, knotted-choppy pulse, common in women. First Tao Ren Cheng Qi Tang; severe cases Di Dang Tang or Dai Di Dang Wan. Deficient patients cannot be purged; treat with Dang Gui Huo Xue San. Blood distension often has irritability, rinsing mouth without swallowing, confusion/manic behavior, pain/stuffiness/wheezing, black stool, clear urine, spontaneous sweating (qi郁 by blood, heat steams sweat), cold extremities, etc. Ren Shen Gui Xiong Tang. Phlegm can stagnate qi, do not say it doesn't cause distension; ancients treated qi distension due to phlegm depression with Jia Wei Zhi Zhu Tang. Qi, Water, Blood diseases often cause each other. Some have qi stagnation first then blood knot (e.g., women with qi depression then amenorrhea). Some have blood knot first then qi stagnation (e.g., women with amenorrhea then qi stagnation/distension). Some have edema first then blood fails (long-term water accumulation penetrates collaterals/tunnels, blood transforms to water). Some have blood knot first then water accumulates (blood knot causes qi stagnation, heat steams water, women with irregular menstruation develop edema/distension/red skin stripes, Jiao Ren Wan, Ren Shen Da Huang Tang). Must treat the root. Accumulation attacking, pain/distension: initially Qi Qi Xiao Ju San; long-term weakness, Shen Zhu Jian Pi Tang with minor digestive aids. Parasite aggregation distension: see Worm section. (Above discusses Qi Distension. Food/Blood/Phlegm/Parasite accumulations, though not solely due to qi stagnation, inevitably involve qi stagnation, so regulation of qi is primary, thus all belong to Qi category.)
Outside zang-fu, in chest/abdomen, pathogen filling causes chest/abdominal distension. Meridians Ying/Wei, qi reaches everywhere, so blood vessels/skin all distend. (Thus names Mai Zhang/Pulse Distension, Fu Zhang/Skin Distension. Mai Zhang: tendons protrude, collateral color changes. Mu Xiang Liu Qi Yin treats Fu Zhang; add Fu Xiong, Jiang Huang for Mai Zhang.) To know which part's pathogen, look at where distension starts and where it is worst. (Spleen/Stomach pathogen starts with epigastric stuffiness. Spleen/Stomach cases have poor appetite; other zang/organs have normal appetite. Skin/meridian distension has normal appetite; GI tract distension has poor appetite. Observe carefully.) Further distinguish deficiency/excess. If zang-fu qi is originally robust but blocked by pathogen, it is Excess. If qi is originally insufficient but obstructed by pathogen, it is Deficiency. (Deficiency may also have excess夹杂, as pathogen is tangible like food/phlegm/blood/damp.) Excess: expel. Deficiency: tonify. Cold: warm. Heat: cool. Knot: disperse. Retention: move. Pathogen entering from exterior to interior and dominating middle: treat exterior first, then harmonize middle. Yin rebelling from lower to middle: suppress first, then harmonize middle. Yang descending from upper to middle: lift first, then harmonize middle. Hands/feet not swollen, only abdomen distended, called Dan Zhang Fu (Single Abdominal Distension), vulgarly Spider Gu, difficult to treat. (Pathogen gathered in zang-fu, not dispersed to limbs. Excess: Hou Po San; Deficiency: Tiao Zhong Jian Pi Wan.) If hands/feet swell after medication, disease moves from interior to exterior, heals soon. If swelling spreads from hands/feet to abdomen, disease moves from exterior to interior, difficult to treat. Men swelling from bottom up (Men yang robust, pathogen rarely invades; gradual upward invasion implies pathogen excess/yang deficiency). Women swelling from top down (Women yin robust, pathogen rarely invades; gradual downward invasion implies pathogen excess/yin deficiency). Both difficult to treat. (Men only lower swelling, women only upper swelling, not concerning, not in difficult category. Like grass...)